Provider Demographics
NPI:1417790320
Name:DIZON, JOSEF NOAH J (OTR/L)
Entity type:Individual
Prefix:
First Name:JOSEF NOAH J
Middle Name:
Last Name:DIZON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:JOSEF NOAH JOSHUA
Other - Middle Name:ESTADILLA
Other - Last Name:DIZON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:228 W POMONA AVE UNIT 247
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4834
Mailing Address - Country:US
Mailing Address - Phone:747-273-6473
Mailing Address - Fax:
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-596-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist